Experts press for Medicaid expansion in Kansas

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October 10, 2016 - 12:00 AM

The need for Medicaid expansion took center stage in Iola Thursday.
A series of speakers spelled out how Medicaid expansion — for Kansans, it’s called KanCare — would benefit rural communities, in particular Iola and Allen County.
“They’re not talking about it in Topeka,” noted Sheldon Weisgrau, director of the Health Reform Resource Project. “That’s why we’re talking about it in Iola.”
Weisgrau and other speakers, Thrive Allen County Executive Director David Toland, Allen County Regional Hospital Chief Executive Officer Tony Thompson, David Jordan of the Alliance for a Healthy Kansas and Iolan Suzan Emmons spent more than an hour detailing how Medicaid expansion is vital to rural areas such as Allen County.
The state’s reluctance to expand Medicaid — made possible through increased federal funding through the Affordable Care Act — has largely been political, Weisgrau said.
And costly.
He estimates the state has refused more than $1.4 billion in federal funds since Jan. 1, 2014.
The increased funding would allow the state to provide health coverage to an additional 150,000 Kansans currently lumped in a “coverage gap,” Weisgrau explained. Those are residents who earn too much to qualify for the existing Medicaid program, but not enough to receive federal tax credits or subsidies to purchase health insurance on their own.
Each day the state refuses to expand Medicaid, the state gives up $1.9 million a day, Weisgrau contended.
Expanded Medicaid could be done without breaking the state budget, he continued. In fact, expansion would be, at worst, “budget neutral” because of the increased federal funding that would reduce expenses in other areas of the state budget.
Accepting the increased funding would equate to an economic stimulus for the state, he said.
“This stimulus would be spent on health care services,” he said. “If it comes to Iola and Allen County, your hospitals have more patients, patients could pay their bills.”
More hospital employees would be hired, more supplies purchased and more business created for vendors, Weisgrau said.
“That’s how an economic stimulus works,” he said. “That’s exactly what’s happened in other states” that have expanded the program.
Thirty-one of the 50 states have increased Medicaid coverage by accepting increased federal funds.
And even among the 19 states that have refused, Kansas stands out, Weisgrau said.
“Most of the other states, they’re at least talking about Medicaid expansion,” he said, even states considered deep red conservative like Kansas, such as Oklahoma, South Dakota and Georgia.
But any talk of similar expansion in Kansas is squashed before it can begin.
Weisgrau pointed to the dismissal of three Kansas lawmakers from the House’s Health and Human Services Committee after all three indicated they’d be willing to see the debate brought to the Statehouse.
“That should bother you,” Weisgrau said. “What should bother you more, they were the ones on the committee who knew the most about health.” (One was a physician, the second a pharmacist, and the third ran a hospital foundation.)
“Not only did we lose the ability to bring up KanCare, but we lost the ability to have good, in-depth intelligent discussions about any health issues. We now have a committee with no experience in health care.”
Talk turned to Independence’s Mercy Hospital, which closed last year in part because of the state’s reluctance to expand Medicaid. That neglect meant Mercy lost out on $1.7 million in added revenue each year.
Not only did Independence lose its hospital, it also lost all of its local doctors, Weisgrau said.
In their absence, surrounding communities with health care services have expanded their reach to Independence, but the quality of care is diminished.
“There is no continuity of care,” he said.
Plus, the community lost 190 jobs in one of its top employers.
Toland later touched on Weisgrau’s comments, noting hospital closures should cause all rural Kansans to shudder.
“To us, Independence is a big town,” Toland said, “and they’ve lost their hospital.”
Independence has almost 9,500 residents, compared to Iola’s 5,600.
State Sen. Jeff King, who lived in Independence, was one of the top opponents of Medicaid expansion for years, Weisgrau said — until the Independence hospital closed.
“That changed his thinking, but it was too late for Independence,” he said.
King has declined to run for re-election this year, and has moved from Independence, Weisgrau said.
The state’s Medicaid qualification guidelines are so strict that a single mother with two children who works half-time at a minimum wage job would earn too much to qualify, Weisgrau said.
That result in a disincentive for many to seek work, he explained, lest they earn too much to receive Medicaid but too little to qualify for ACA subsidies.
Even so, Weisgrau estimated more than half of those who would receive coverage under expanded Medicaid are already employed, many working multiple, albeit low-paying, jobs.

TOLAND WAS even more pointed, serving up a blistering critique of Gov. Sam Brownback and the State Legislature for its refusal to consider Medicaid expansion.
“It’s incredible to me as a Kansan, that our fellow Kansans in the Legislature are knowingly inflicting harm on our community and communities across the state by refusing to expand KanCare,” Toland said. “Let there be no mistake. The greatest enemy to Kansas communities like ours is not Washington, D.C. It’s Topeka; it’s what’s happening up the road, less than two hours away.
“For the sake of our community have to stop lurching from one self-inflicted crisis to the next,” Toland concluded. “We’ve got to stop this blind adherence to ideology.”
Toland drove home his point by illuminating a common site in convenience stores in Iola, Allen County and across the country — collection jars.
The jars may be a benefit for somebody recently diagnosed with cancer or in an auto accident, “or to help pay for a surgery,” Toland said.
“This is how we fund health care for the working poor,” he continued. “We are the wealthiest country in the history of the world, and this is how we are choosing to fund health care.
“That’s crazy. We can do so much better.”

THOMPSON SPOKE about how much expanded Medicaid would benefit the local hospital.
Even with lost federal funding through sequestration cuts — an unfortunate byproduct of not passing a federal budget in time — Allen County Regional Hospital would net an increased $1.6 million or more from the feds if KanCare were expanded.
For perspective’s sake, Thompson noted that added revenue — more than $33 million over the next 20 years — would largely pay off the bonds used to construct the new hospital.
“Think of that like your home mortgage,” Thompson said.
Talking locally, Thompson said, will lead to increased conversation in Topeka.

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